What is the Qualified Medicare Beneficiary (QMB) Medicaid Program?

Qualified Medicare Beneficiary (QMB) is a Medicaid program for people who are already receiving Medicare benefits. The purpose of the program is to reduce the cost of medications and copays for doctors, hospitals, and medical procedures.

Important Note: The QMB program may differ by state. For the purpose of this article, we are discussing the QMB program as it relates to Florida.

Typically, this program is used by individuals and couples still living at home in the community. However, it can also be used by people who live in Assisted Living, Independent Living, or a Group Home.

As with all Medicaid programs, QMB has income and asset limits that must be met in order for someone to qualify for this program. The current limits for QMB as of July, 2017 are:

Medicare Part D premium reduced or covered through the Low Income Subsidy (LIS) / Extra Help program

Medication costs reduced to $0 – $10 for most medications through the LIS / Extra Help program

No Donut Hole / Coverage Gap

Medicare deductibles paid by Medicaid

Medicare coinsurance and copays within prescribed limits paid

Here is an example of how the QMB program can help someone:

When in the Donut Hole, Insulin costs $360 per month. With QMB, the cost is reduced to $3.60 per month.

When on QMB, you save from $109.00 to $134.00* (depending on which amount is being deducted) on your monthly Medicare Part B premium, as this is paid back into your social security check. *Average cost for Medicare Pt B premium. May be more.

No copays for doctors, hospital visits, or medical procedures for Medicare approved expenses.

How Can A Pooled Trust Help Me Qualify for QMB?

If your income or assets are over the financial limits for the QMB program, and you have medical conditions that prevent you from working, a Pooled Trust can be used to qualify for the program.

Setting up a Pooled Trust allows you to place your over income and/or over asset (or both) into the trust, making this overage no longer “countable” for Medicaid purposes. This means that while Medicaid acknowledges your total income and/or assets, they deduct the income and/or assets placed into the trust from the total, so that it no longer counts against you.

Example 1:

An individual making $1,800 from Social Security cannot qualify for QMB because they are over the $1,005 income limit. By opening a Pooled Trust account, and placing $800 into the trust each month, Medicaid only “counts” the person as having $1,000 in monthly income. They will need to make deposits into the trust every month to keep their countable income under the limit.

Example 2:

An individual making $975 / month from Social Security is under the income limit. However, if that individual has $10,000 in savings, they are over the QMB asset limit of $7,390. By opening a Pooled Trust account, and placing $3,000 into the trust, the over asset issue is eliminated, allowing the person to financially qualify for QMB. If at any time their countable assets outside of the trust get close to the QMB asset limit, they can make additional deposits into the trust to continue to meet the program limits.

With either example, AGED as the Trustee may use the money in the trust to pay bills and expenses for the individual (known as the beneficiary), as long as the expenses are for the sole benefit of the beneficiary, and are not paid for by government benefits. Examples of bills paid from the trust include, but are not limited to, mortgage, rent, facility bills, utilities, repairs, auto insurance, auto payment, etc. However, the trust cannot pay the beneficiary directly, as this could disqualify them from the QMB program.

Setting up a Pooled Trust is easy. Refer to our Forms page to view the documents needed to establish and AGED Trust. (link: www.trustaged.org/forms/)

AGED, Inc. is a nonprofit Pooled Trust company that assists seniors and the disabled with financially qualifying for Medicaid. We are not attorneys. A trust is a legal instrument, and we recommend seeking legal counsel to determine if a trust is right for you.